Literature DB >> 22065670

Hyperprolactinemia: An often missed cause of male infertility.

Pratibha Singh1, Manish Singh, Goutham Cugati, Ajai Kumar Singh.   

Abstract

Entities:  

Year:  2011        PMID: 22065670      PMCID: PMC3205532          DOI: 10.4103/0974-1208.86094

Source DB:  PubMed          Journal:  J Hum Reprod Sci        ISSN: 1998-4766


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Sir, Prolactinoma is the most common tumor of pituitary gland, comprising up to 45% of all pituitary tumors.[1] Prolactinoma is the most common cause of hyperprolactinemia, which is a common cause of infertility in males and females.[12] Clinical presentation of the prolactinomas are earlier in females compared with males, even when they are very small (microadenoma).[12] This earlier presentation in females is due to greater symptom burden caused by hyperprolactinemia in them.[1] On the other hand, males present late till prolactinoma becomes large in size (macroprolactinoma) and start causing pressure over optic chiasm and presented as visual deterioration or visual field defects. They can also present with decreased libido.[1] So clinical diagnosis of prolactinoma in male patents is late, which can lead to misdiagnosis of microprolactinoma in male patients.[2] Hyperprolactinemia causes infertility in around 11% of oligospermic males.[3] Hyperprolactinemia inhibits the pulsatile secretion of the gonadotrophin releasing hormone, which causes decreased pulsatile release of follicle stimulating hormone, luteinizing hormone, and testosterone, which in turn causes spermatogenic arrest, impaired sperm motility, and altered sperm quality.[3] It later produces secondary hypogonadism and infertility.[3] Hyperprolactinemia also directly influences spermatogenesis and steroidogenesis by acting on prolactin receptors present in Sertoli cells and Leydig cells in testes, and produces primary hypogonadism and infertility.[3] It is seen that oligospermic or azoospermic patients with normal serum levels of gonadotrophins show relatively higher serum levels of prolactin, proving a role of prolactin in gametogenesis, which is independent of gonadotrophins.[35] There are many studies suggesting that hyperprolactinemia has a definite role in the male infertility, and is one of the reversible causes of infertility.[2-5] It can be managed medically with simple medication, such as bromocriptine and cabergoline, which normalizes serum prolactin levels, restoration of gonadal function, reversing infertility caused by hyperprolactinemia and induces reduction in the prolactinoma size in the majority of patients.[246] It is a common and reversible cause of male infertility, and has excellent results with dopamine agonist drugs.[246] Misdiagnosis of hyperprolactinemia in male can lead to irreversibility of this condition and may lead toward unnecessarily expansive procedures, such as in vitro fertilization (IVF) for achieving pregnancies. In infertility clinic, if male patients present with decreased libido, erectile dysfunction, and hypogonadism, and semen microscopic analysis shows oligospermia or azoospermia, impaired sperm motility, or altered sperm quality, a routine evaluation of serum prolactin level should be done, which can avoid unnecessary, costly, and invasive investigation (eg, testicular biopsy) for evaluation of male infertility.[2-6] Hyperprolactinemia is a common cause of infertility in males but the latest European guidelines published in European Urology 2005 and revised in 2010 for evaluation of male infertility has not included the hormonal assessment of the serum prolactin level during evaluation of male infertility.[7] After reviewing the literature, a routine evaluation of the serum prolactin level should be done in male infertility cases and included in the guideline for evaluation of male infertility. This will prevent misdiagnosis of hyperprolactinemia, avoid unnecessary costly investigations, and guide toward appropriate management to achieve pregnancy.
  6 in total

1.  EAU guidelines on male infertility.

Authors:  G R Dohle; G M Colpi; T B Hargreave; G K Papp; A Jungwirth; W Weidner
Journal:  Eur Urol       Date:  2005-07-01       Impact factor: 20.096

2.  The epidemiology of prolactinomas.

Authors:  Antonio Ciccarelli; Adrian F Daly; Albert Beckers
Journal:  Pituitary       Date:  2005       Impact factor: 4.107

Review 3.  Hyperprolactinemia in men: clinical and biochemical features and response to treatment.

Authors:  Michele De Rosa; Stefano Zarrilli; Antonella Di Sarno; Nicola Milano; Maria Gaccione; Bartolomeo Boggia; Gaetano Lombardi; Annamaria Colao
Journal:  Endocrine       Date:  2003 Feb-Mar       Impact factor: 3.633

4.  Effect of bromocriptine treatment on male infertility associated with hyperprolactinemia.

Authors:  N Laufer; H Yaffe; E J Margalioth; J Livshin; M Ben-David; J G Schenker
Journal:  Arch Androl       Date:  1981-06

Review 5.  [Correlation of serum prolactin, sperm count and motility. Prevalence of hyperprolactinemia in the infertile male].

Authors:  J M Soler Fernández; F Caravaca Magariños; C Domínguez Bravo; J Murillo Mirat; A Aparicio Palomino; J Herrera Puerto
Journal:  Arch Esp Urol       Date:  1990-10       Impact factor: 0.436

Review 6.  Hyperprolactinemia and sexual function in men: a short review.

Authors:  J Buvat
Journal:  Int J Impot Res       Date:  2003-10       Impact factor: 2.896

  6 in total
  11 in total

1.  Status of Serum Prolactin Levels among Male Cohort in Infertile Couples.

Authors:  Kinikanwo I Green; Collins Amadi
Journal:  Int J Appl Basic Med Res       Date:  2020-10-07

2.  Evaluation of the effect of vitamin D supplementation on spermatogram, seminal and serum levels of oxidative stress indices in asthenospermia infertile men: a study protocol for a triple-blind, randomized controlled trial.

Authors:  Leila Maghsoumi-Norouzabad; Ahmad Zare Javid; Anahita Mansoori; Mohammadreza Dadfar; Amirarsalan Serajian
Journal:  Nutr J       Date:  2021-06-02       Impact factor: 3.271

3.  Morbid Obesity Due to Prolactinoma and Significant Weight Loss After Dopamine Agonist Treatment.

Authors:  Muzaffar Ali; Lubna Mirza
Journal:  AACE Clin Case Rep       Date:  2021-03-11

Review 4.  Endocrine aberrations of human nonobstructive azoospermia.

Authors:  Yong Tao
Journal:  Asian J Androl       Date:  2022 May-Jun       Impact factor: 3.054

5.  Ascorbic acid treatment elevates follicle stimulating hormone and testosterone plasma levels and enhances sperm quality in albino Wistar rats.

Authors:  Uduak Akpan Okon; Ikponoabasi Ibanga Utuk
Journal:  Niger Med J       Date:  2016 Jan-Feb

6.  Hyperprolactinaemia in male infertility: Clinical case scenarios.

Authors:  Zeinab Dabbous; Stephen L Atkin
Journal:  Arab J Urol       Date:  2017-11-16

7.  The Therapeutic Effects of Traditional Chinese Medicine for Poor Semen Quality in Infertile Males.

Authors:  Shu-Chiu Wang; Shu-Chen Wang; Chia-Jung Li; Ching-Heng Lin; Hsiao-Lin Huang; Liang-Miin Tsai; Chiung-Hung Chang
Journal:  J Clin Med       Date:  2018-08-24       Impact factor: 4.241

Review 8.  Endocrinopathies and Male Infertility.

Authors:  Pallav Sengupta; Sulagna Dutta; Ivan Rolland Karkada; Suresh V Chinni
Journal:  Life (Basel)       Date:  2021-12-22

9.  Yishentongluo decoction in treatment of idiopathic asthenozoospermia infertility: Study protocol for a randomized controlled trial.

Authors:  Qi Zhang; Lipeng Fan; Fangyuan Li; Zixue Sun; Chenming Zhang; Rubing Chen
Journal:  Medicine (Baltimore)       Date:  2020-10-23       Impact factor: 1.817

10.  The effects of Vitamin D3 supplementation on Spermatogram and endocrine factors in asthenozoospermia infertile men: a randomized, triple blind, placebo-controlled clinical trial.

Authors:  Leila Maghsoumi-Norouzabad; Ahmad Zare Javid; Anahita Mansoori; Mohammadreza Dadfar; Amirarsalan Serajian
Journal:  Reprod Biol Endocrinol       Date:  2021-07-05       Impact factor: 5.211

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